RESUMO
BACKGROUND: To assess the diagnostic value of echocardiography in detecting the various types of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). METHODS: A total of 30 patients with an established diagnosis of ALCAPA were retrospectively analyzed, and classified into infant- (n=20) and adult-type (n=10) groups according to the age of symptom manifestation and the mode of presentation. All patients underwent echocardiography examination. RESULTS: Twenty-four out of thirty patients were diagnosed with ALCAPA by echocardiography. The remaining six cases were confirmed by dual-source computed tomography (DSCT) and angiocardiography, respectively. In the infant-type group, there was negligible or no collateral flow between the right coronary artery (RCA) and the left coronary artery (LCA). Eighteen of these patients had enhanced echogenicity of left ventricular (LV) papillary muscles, different degrees of mitral regurgitation (MR) and the RCA to aortic annulus ratio (RCA/AO) was >0.12. In the adult-type group, all ten patients had RCA dilation and significant development of collateralization from the RCA to the dilated LCA. They all had mild MR and RCA/AO was >0.20. Preoperatively, left ventricular ejection fraction (LVEF) was significantly lower in infant-type group than in adult-type group (46.24%±5.47% vs. 61.43%±6.38%, P<0.01). Cardiac surgery significantly improved post-operative LVEF (60.12%±6.02%, P<0.01 vs. pre-operation) in infant-type group. CONCLUSIONS: Echocardiography plays a pivotal role in detecting ALCAPA. Imaging and clinical features differ significantly between infant- and adult-type cases.
RESUMO
This study aims to investigate the imaging quality and radiation dose of prospective ECG-triggered 256 multi-slice computer tomography (MSCT) in accessing the coronary artery (CA) in children. Coronary arteries of 149 children were evaluated using prospective ECG-triggered 256 MSCT with the same system settings. A four-point scoring system was applied to study the capability of MSCT in detecting CA in these patients. Signal, noise and contrast-to-noise ratios (CNR) were analyzed to investigate the association of image quality with age. Then, volumetric CT dose index (CTDIvol), dose-length product (DLP), and effective dose (ED) were utilized to study the association of radiation dose with age. The detection rate for original, proximal, middle, distal and the 11 segments of CA was 100, 97, 92, 81 and 92%, respectively; and there was no influence on age during the detection (all, P < 0.05). A negative correlation was found between ED and age (r = -0.664, P < 0.001). Significantly larger EDs were found in younger patients (age: <3 years; 1.2 ± 0.5 and 0.6 ± 0.2 mSv; P < 0.001), while higher DLPs were found in elder patients, although no correlation was found between ages versus DLP (r = 0.092, P = 0.262). Prospective ECG-triggered 256 MSCT has considerable performance for the evaluation of CA in children. However, great caution is needed for children under the age of three in the selection of this examination. Furthermore, the tube current could be further reduced for the examination of children ≥8 years.
